Method of Inoculation Influences the Survival of Salmonella enterica on Retail and Orchard Peaches.

Challenge studies associated with fruits and vegetables generally utilize wet bacterial inoculation methods. However, a recent salmonellosis outbreak in the U.S. was linked to peaches plausibly contaminated via fugitive dust from a nearby animal operation. This outbreak has highlighted the need for a suitable inert carrier which can be used for the dry transfer of Salmonella enterica to produce. The purpose of this study was 1) to examine the population stability of S. enterica and its surrogate, Enterococcus faecium, in different dry matrices during extended storage to identify suitable carriers and 2) to evaluate the survival of S. enterica on peaches based on the mode of contamination (i.e., wet vs. dry). S. enterica and E. faecium were cultivated on tryptic soy agar (TSA) and inoculated into corn-cob small animal litter, sand, or silica at 10-11 log CFU/g. Matrices were mixed by hand and stored at 25°C and 33% relative humidity for up to 120 d. S. enterica remained relatively stable in the silica and litter, with no significant decrease in population after 14 and 28 d, respectively. E. faecium significantly reduced in all matrices, with the greatest reduction observed in silica (2.86 log CFU/g after 120 d). Additional carriers would need to be assessed for E. faecium which could maintain its population stability. Silica was ultimately selected for the dry carrier of S. enterica. Peaches available at retail or from orchards were inoculated with S. enterica using the silica carrier or by spot or dip inoculation methods at 5 log CFU/peach and stored at 5°C and 80% relative humidity for up to 28 d. The population of S. enterica significantly reduced on all peaches except for the dry inoculated orchard peaches, where the population remained stable (4.62 ± 0.35 log CFU/peach after 28 d). Results from this study determined that the mode of contamination influences the survival of S. enterica on peaches and that dry inoculation methods should be considered for produce in some instances.

Survival of Listeria monocytogenes on Frozen Vegetables during Long-term Storage at -18 and -10°C.

Two recent listeriosis outbreaks have occurred in the United States and Europe due to contaminated individually quick-frozen (IQF) vegetables. While one of the outbreaks was due to frozen vegetables considered ready-to-eat (RTE), the other was linked to frozen corn whose packaging contained cooking instructions and was considered not-ready-to-eat (NRTE). However, consumers may thaw certain frozen vegetables and consume without cooking. Since no data is available on the survivability of L. monocytogenes on IQF vegetables during frozen storage, this study examined the population of six different strains (comprising lineages 1/2a, 1/2b, and 4b) on IQF vegetables during long-term storage. Individual strains were inoculated onto an IQF vegetable mix at 4 log CFU/g and stored at -18 or -10°C for 360 days. Although fluctuations in populations of all strains were observed on the vegetables during storage, no significant differences based on strain, lineages, or temperature were observed. Overall, L. monocytogenes populations were only reduced by up to 0.47 and 0.59 log CFU/g after 360 days at -18 and -10°C, respectively. Results from this study suggest that L. monocytogenes is able to persist on IQF vegetables for extended time periods with no significant reduction in population. Future studies could evaluate the survival and growth of L. monocytogenes on IQF vegetables during thawing and storage.

Long-Term Survival of Listeria monocytogenes in Nut, Seed, and Legume Butters.

Nut, seed, and legume butters have become increasingly popular with consumers. Listeria monocytogenes contamination of a variety of butters has resulted in several recalls, although no known outbreaks have been identified. L. monocytogenes has been shown to survive on a variety of seeds for up to 6 months, legumes and nuts for over 12 months, and in peanut butter and peanut-chocolate spreads for 21 to 60 weeks depending on formulation; however, long-term survival in other butters has not yet been characterized. In this study, the survival of L. monocytogenes in various nut, seed, legume, and chocolate-containing butters (n = 10) based on inoculation level, storage temperature, and the pH, aw, and nutrient contents of the butters was examined. First, butters were inoculated with L. monocytogenes at 4 log CFU/g and stored at either 5 or 25°C with enumeration and/or enrichment at intervals over 12 months. L. monocytogenes survived in all butters examined with no significant change in population after storage at 5°C, whereas the population was reduced to <1.70 log CFU/g in as little as 3 months at 25°C; the only exception was for sunflower butter, where L. monocytogenes decreased approximately 1 log CFU/g. Subsequently, all butters were inoculated at 1 log CFU/g and stored at 25°C for 6 months with enrichment during storage. L. monocytogenes was detected in all butters, except pecan butter, after 6-month storage. Butters containing chocolate did not inhibit L. monocytogenes survival, regardless of the inoculation level. Results indicate there may be an association between high-fat and carbohydrate level and survivability of L. monocytogenes in various types of butters. This work highlights the need to mitigate the potential for cross-contamination of L. monocytogenes into nut, seed, and legume butters due to the potential for long-term survival.

The impact of fear of hypoglycaemia on sleep in adolescents with type 1 diabetes.

AIMS: Fear of hypoglycaemia (FOH) can contribute to impaired sleep for adults with type 1 diabetes (T1D) and parents of children with T1D, although it is unknown how FOH may affect sleep for adolescents with T1D. This study examines the relationship between adolescent FOH and sleep and assessed the influences of continuous glucose monitor (CGM) and insulin pump use. METHODS: Adolescents ages 14-18 years with T1D completed questionnaires evaluating FOH (Child Hypoglycemia Fear Survey) and sleep (Pittsburgh Sleep Quality Index, PSQI). Analyses included linear and logistic regression, t-tests and Fisher's exact tests. RESULTS: Participants included 95 adolescents (52 female) with a median (IQR) age of 16.5 (15.3-17.7) years and a T1D duration of 5.7 (2.5-9.6) years. Analyses showed increased FOH-Worry subscale scores were associated with reduced sleep duration (ß = -0.03, p = 0.042, adjusting for BMI z-score, race and ethnicity) and increased sleep disturbances (OR = 1.1, p = 0.038, adjusting for race and ethnicity). Frequent CGM users had longer sleep duration (average 7.5 h) compared with infrequent or non-CGM users (average = 6.8 h; p = 0.029), and pump users had overall improved sleep health as determined by PSQI score (p = 0.019). Technology use did not have significant interactions in the relationships between FOH and sleep duration or sleep disturbances. CONCLUSIONS: Worrying about hypoglycaemia was associated with impaired sleep for adolescents with T1D. Diabetes technology users have some sleep improvements, but CGM and pump use do little to alter the relationship between FOH and sleep outcomes.

Virtual reality for management of cancer pain: Study rationale and design.

BACKGROUND: Patients with cancer commonly experience acute and/or chronic moderate to severe pain related to disease, treatment, or both. While pain management strategies typically focus on drug therapies, non-pharmacological interventions may prove beneficial without risk of significant clinical side effects or contraindications. One novel strategy, virtual reality, has been shown to improve pain control in addition to usual pharmacological interventions. METHODS: This is a prospective, two-armed, single center randomized controlled study of a virtual reality intervention in 128 hospitalized subjects with cancer reporting pain rated at least 4/10 compared to an active control intervention, two-dimensional guided imagery. The primary outcome is change in self-reported pain score. Secondary end points include changes in self-reported distress, quality of life, and satisfaction with pain management. We will also explore patient preferences for distraction therapy content and themes through quantitative analysis of survey data, semi-structured interviews, and a collaging exercise. CONCLUSION: This randomized controlled study aims to provide empiric data to support application and expansion of novel technologies such as virtual reality to augment usual pharmacological pain management strategies in hospitalized patients with cancer.

Virtual reality for pain management in advanced heart failure: A randomized controlled study.

BACKGROUND: Hospitalized patients with advanced heart failure often experience acute and/or chronic pain. While virtual reality has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management on this patient population. AIM: To investigate the impact of a virtual reality experience on self-reported pain, quality-of-life, general distress, and satisfaction compared to a two-dimensional guided imagery active control. DESIGN: Single-center prospective randomized controlled study. The primary outcome was the difference in pre- versus post-intervention self-reported pain scores on a numerical rating scale from 0 to 10. Secondary outcomes included changes in quality-of-life scores, general distress, and satisfaction with the intervention. SETTING/PARTICIPANTS: Between October 2018 and March 2020, 88 participants hospitalized with advanced heart failure were recruited from an urban tertiary academic medical center. RESULTS: Participants experienced significant improvement in pain score after either 10 minutes of virtual reality (change from pre- to post -2.9 ± 2.6, p < 0.0001) or 10 minutes of guided imagery (change from pre- to post -1.3 ± 1.8, p = 0.0001); the virtual reality arm experienced a 1.5 unit comparatively greater reduction in pain score compared to guided imagery (p = 0.0011). Total quality-of-life and general distress scores did not significantly change for either arm. Seventy-eight participants (89%) responded that they would be willing to use the assigned intervention again. CONCLUSION: Virtual reality may be an effective nonpharmacologic adjuvant pain management intervention in hospitalized patients with heart failure. TRIAL REGISTRATION: ClinicalTrials.gov database (NCT04572425).

Microbiomes of commercially-available pine nuts and sesame seeds.

Metagenomic analysis of food is becoming more routine and can provide important information pertaining to the shelf life potential and the safety of these products. However, less information is available on the microbiomes associated with low water activity foods. Pine nuts and sesame seeds, and food products which contain these ingredients, have been associated with recalls due to contamination with bacterial foodborne pathogens. The objective of this study was to identify the microbial community of pine nuts and sesame seeds using targeted 16S rRNA sequencing technology. Ten different brands of each seed type were assessed, and core microbiomes were determined. A total of 21 and 16 unique taxa with proportional abundances >1% in at least one brand were identified in the pine nuts and sesame seeds, respectively. Members of the core pine nut microbiome included the genera Alishewanella, Aminivibrio, Mycoplasma, Streptococcus, and unassigned OTUs in the families of Desulfobacteraceae and Xanthomonadaceae. For sesame seeds, the core microbiome included Aminivibrio, Chryseolina, Okibacterium, and unassigned OTUs in the family Flavobacteriaceae. The microbiomes of these seeds revealed that these products are dominated by environmental bacterial genera commonly isolated from soil, water, and plants; bacterial genera containing species known as commensal organisms were also identified. Understanding these microbiomes can aid in the risk assessment of these products by identifying food spoilage potential and community members which may co-enrich with foodborne bacterial pathogens.

Chronic Intravenous Inotropic Support as Palliative Therapy and Bridge Therapy for Patients With Advanced Heart Failure: A Single-Center Experience.

BACKGROUND: Many patients with American College of Cardiology/American Heart Association Stage D (advanced) heart failure are discharged home on chronic intravenous inotropic support (CIIS) as bridge to surgical therapy or as palliative therapy. This study analyzed the clinical trajectory of patients with advanced heart failure who were on home CIIS. METHODS: We conducted a single-institution, retrospective cohort study of patients on CIIS between 2010 and 2016 (n = 373), stratified by indication for initiation of inotropic support. Study outcomes were time from initiation of CIIS to cessation of therapy, time to death for patients who did not receive surgical therapy and rates of involvement with palliative care. RESULTS: Overall, patients received CIIS therapy for an average of 5.9 months (standard deviation [SD] 7.3). Patients on CIIS as palliative therapy died in an average of 6.2 months (SD 6.6) from the time of initiation of CIIS, and those on CIIS as bridge therapy who did not ultimately receive surgical therapy died after an average of 8.6 months (SD 9.3). Patients who received CIIS as bridge therapy were significantly less likely to receive palliative-care consultation than those on inotropes as palliative therapy, whether or not they underwent surgery. CONCLUSIONS: In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived for 6.2 months, on average, with wide variation among patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality rate in this subgroup.

Effect of Time, Temperature, and Transport Media on the Recovery of Listeria monocytogenes from Environmental Swabs.

ABSTRACT: Environmental monitoring for Listeria monocytogenes in food processing environments is key for ensuring the safety of ready-to-eat foods. For sampling, swabs are often hydrated with a wetting or transport medium that may contain neutralizers and other ingredients. After swabbing the environment, the swabs may then be transported or shipped cold to an off-site laboratory for testing, ideally within 48 h. Extended shipping times may subject the pathogen to increased temperatures in the presence of the wetting medium, organics, and other chemicals from the processing facility that could confound detection. This study evaluated growth and detection of L. monocytogenes on stainless steel exposed to either buffer or sodium hypochlorite before drying. Swabs were rehydrated with Butterfield's phosphate buffer, neutralizing buffer, Letheen broth, or Dey-Engley neutralizing broth before swabbing. Swabs were stored in the presence of no added food, cheese whey, or ice cream under both optimal (4°C) and suboptimal (15°C) temperatures for up to 72 h. Overall, there was no growth of L. monocytogenes at 4°C through 72 h of storage, although enrichment from these swabs was dependent on the presence and type of food matrix. Pathogen growth during storage at 15°C was more variable and depended on both the food matrix and transport media used, with Dey-Engley and Letheen broths allowing for the highest population increases. Overall, more enrichments resulting in L. monocytogenes detections were observed when using Letheen broth and neutralizing buffer than Dey-Engley broth, which resulted in fewer detections at 15°C. Logistic regression and Cochran-Mantel-Haenszel analyses determined that storage temperature, transport media, and food matrix all significantly affected detection of L. monocytogenes, whereas storage time did not have a clear effect on recovery from swabs.

Evaluation of Methods of Enrichment and Compositing of Environmental Samples for Detection of Listeria monocytogenes.

ABSTRACT: Various methods exist for the enrichment and detection of Listeria spp. and Listeria monocytogenes from environmental samples. Procedures for the compositing of environmental samples are not as well defined. In this study, different enrichment procedures involving buffered Listeria enrichment broth (BLEB), University of Vermont medium (UVM), and Fraser broth (FB) were evaluated to determine the limits of detection (LODs) for L. monocytogenes from culture and from swabs of stainless steel and to assess the efficacy of composite sampling by wet (pooling of primary enrichments) and dry (pooling of swabs) procedures. For detection of cells in pure culture, the computed values for the LOD at 95% probability (LOD95) using a single-step BLEB or two-step UVM-FB enrichment were 0.33 and 0.49 CFU/225 mL enrichment, respectively. No significant differences in detection were observed for procedures using either two-step BLEB-FB or UVM-FB enrichments for swabs of stainless steel when L. monocytogenes was inoculated at 2 to 6 log CFU; the LOD95 values were 3.82 and 3.62 log CFU per 4-in2 area, respectively. Wet compositing of L. monocytogenes from culture with and without romaine lettuce wash resident microbiota was conducted using BLEB-FB and UVM-FB enrichment methods; both allowed detection of the pathogen at ratios of 1:1, 1:2, 1:4, and 1:7 (1 positive sample to x negative samples) with no loss in sensitivity. From swabs of stainless steel, L. monocytogenes was detected similarly for both wet and dry composites of up to eight samples (1:7) with romaine lettuce wash. However, the BLEB-FB method allowed significantly faster detection (after 24 h of FB incubation) in composites of 1:4 and 1:7 samples compared with the UVM-FB method under the conditions tested. The results of this study provide data to evaluate the efficacies of the different enrichment procedures and aid in assessing the use of wet and dry compositing of environmental samples for use as part of a Listeria control plan in food production and processing facilities.

E-consults: an effective way to decrease clinic wait times in rheumatology.

BACKGROUND: To evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology. METHODS: We conducted a pre-post study of E-consult implementation for positive ANA referrals. We retrospectively reviewed "positive ANA" referrals from 1/2015-3/2017. A statistical process control chart was created to display monthly average wait times for in-person clinic visits and to identify special cause variation. Final diagnoses, wait times and resource utilization were recorded and compared between E-consults and in-person referrals. RESULTS: There were 139 referrals for positive ANA with 126 occurring after E-consult implementation in August 2015. Forty-four percent (55/126) of referrals were E-consults; 76% did not have an in-person visit after initial electronic rheumatology recommendation. A control chart demonstrated special cause variation in the form of a shift from June 2016 - January 2017, suggesting a temporal association between decreased wait times and the implementation of E-consults. Eleven patients were diagnosed with ANA-associated rheumatic disease; the majority of patients (73%, 86/139) did not have a rheumatologic diagnosis. Overall E-consults utilized more labs than in-person visits, but this was not statistically significant. In-person visits utilized more imaging studies, which was statistically significant. CONCLUSION: E-consults are an effective way to address positive ANA consults without significant increase in resource utilization and were temporally associated with decreased wait times for in-person visits.

Listeria monocytogenes growth kinetics in refrigerated ready-to-eat dips and dip components.

Refrigerated ready-to-eat (RTE) dips often have pH and water activity combinations conducive to the proliferation of foodborne pathogens, including Listeria monocytogenes. This study conducted product assessments of five refrigerated RTE dips: baba ghanoush, guacamole, hummus, pesto, and tahini, along with individual dip components including avocado, basil, chickpeas, cilantro, eggplant, garlic, and jalapeno pepper. Dips and dip components were inoculated with 2 log CFU/g of L. monocytogenes and stored at 10°C for 28 days. The pathogen was enumerated throughout storage and growth rates were determined using the DMFit program to compute the time required for L. monocytogenes to achieve a 1 log CFU/g increase in population. Survival and growth rates varied significantly between the refrigerated RTE dips and dip components assessed in this study. For dips, L. monocytogenes progressively decreased in baba ghanoush, pesto, and tahini. In contrast, the pathogen proliferated in both hummus and guacamole and the highest growth rate was observed in guacamole (0.34±0.05 log CFU/g per day) resulting in a 1 log CFU/g increase in population in 7.8 days. L. monocytogenes proliferated in all dip components with the exception of eggplant and garlic. The pathogen achieved the highest growth rate in chickpeas (2.22±1.75 log CFU/g per day) resulting in a computed 1 log CFU/g increase in only 0.5 days. Results from this study can aid in understanding how L. monocytogenes behaves in refrigerated RTE dips and dip components and data can be utilized in understanding product formulations and in risk assessments.

Efficacy of quality improvement and patient safety workshops for students: a pilot study.

BACKGROUND: While the Association of American Medical Colleges encourages medical schools to incorporate quality improvement and patient safety (QI/PS) into their curriculum, medical students continue to have limited QI/PS exposure. To prepare medical students for careers that involve QI/PS, the Institute for Healthcare Improvement chapter at an allopathic medical school and school of allied health professions initiated self-directed learning by offering student-led workshops to equip learners with skills to improve the quality and safety of healthcare processes. METHODS: In this prospective cohort study, workshops were hosted for medical students between 2015 and 2018 on five QI/PS topics: Process Mapping, Root-Cause Analysis (RCA), Plan-Do-Study-Act (PDSA) Cycles, Evidence Based Medicine (EBM), and Patient Handoffs. Each workshop included a hands-on component to engage learners in practical applications of QI/PS skills in their careers. Change in knowledge, attitudes, and behaviors was assessed via pre- and post-surveys using 5-point Likert scales, and analyzed using either the McNemar test or non-parametric Wilcoxon signed-rank test. Surveys also gathered qualitative feedback regarding strengths, future areas for improvement, and reasons for attending the workshops. RESULTS: Data was collected from 88.5% of learners (n = 185/209); 19.5% of learners reported prior formal instruction in these topics. Statistically significant improvements in learners' confidence were observed for each workshop. Additionally, after attending workshops, learners felt comfortable teaching the learned QI/PS skill to colleagues (mean pre/post difference 1.96, p < 0.0001, n = 139) and were more likely to pursue QI/PS projects in their careers (mean pre/post difference 0.45, p < 0.0001, n = 139). Lastly, learners demonstrated a statistically significant increase in knowledge in four out of five skills workshop topics. CONCLUSION: Few medical students have formal instruction in QI/PS tools. This pilot study highlights advantages of incorporating an innovative, student-directed modified 'flipped classroom' methodology, with a focus on active experiential learning and minimal didactic instruction.

Short communication: Long-term -20°C survival of Listeria monocytogenes in artificially and process-contaminated ice cream involved in an outbreak of listeriosis.

Listeria monocytogenes was linked to an outbreak of foodborne illness associated with in-process contaminated ice cream in the United States from 2010 to 2015 that sickened 10 individuals and led to 3 deaths. Ice cream obtained from the outbreak was used in this study to examine the population dynamics of L. monocytogenes as in-process contaminants compared with artificially inoculated cells. Because challenge studies of food products generally use artificial contamination, it is necessary to understand the differences in survival, if any, between these 2 types of contaminants. We hypothesized that laboratory-grown cultures of the pathogen that were not exposed to the environmental stresses of the manufacturing facility would show different population dynamics in an ice cream challenge study compared with in-process contaminants. In this study, half of the outbreak-associated ice cream samples were artificially inoculated with a 10 cfu/g cocktail of L. monocytogenes; the other half contained only the in-process contaminants. All samples were stored at -20°C and tested for pathogen levels (n = 10 for each contaminant type at each time point) by the most probable number method at 3-mo intervals for 36 mo. Generally, population levels between the 2 contamination states in the ice cream were not significantly different and L. monocytogenes survived for at least 36 mo, regardless of contamination state. Overall, our results suggest that the use of L. monocytogenes as an artificial contaminant in challenge studies and risk assessment of ice cream during frozen storage give results similar to those shown by in-process contaminants.

Survival kinetics of Listeria monocytogenes on chickpeas, sesame seeds, pine nuts, and black pepper as affected by relative humidity storage conditions.

Nuts and seeds have been increasingly associated with recalls due to contamination with Listeria monocytogenes. Storage of these food commodities occurs at various relative humidity (RH) conditions for months or years. The objective of this study was to assess L. monocytogenes survival on four commodities representing dried legumes, seeds, and spices categories: chickpeas, sesame seeds, pine nuts, and black pepper kernels. Inoculated products at 10 log CFU/g were stored for 180 days (6 months) at 25°C and different relative humidity (RH) levels: 25% (low), 45% (ambient), and 75% (high). After 180 days at 25% RH, L. monocytogenes populations decreased to 2.67-6.59 log CFU/g; the highest survival of the pathogen was observed on pine nuts and sesame seeds with decay rates of -0.014± 0.001 log CFU/g per d. Significantly greater population reductions on all products were observed during storage at 45 and 75% RH. At 45% RH, L. monocytogenes levels decreased to 1.90-6.36 log CFU/g. On chickpeas and black pepper stored at 75% RH, the pathogen population decreased to below the limit of enumeration (1 log CFU/g) yet were still detected via enrichments. The lowest survival of L. monocytogenes occurred at 75% RH on black pepper with a decay rate of -0.058±0.003 log CFU/g per d. Overall, regardless of RH level, the ability of the products to support survival of the pathogen may be expressed in the following order: pine nuts > sesame seeds > chickpeas > black pepper. The results of this study can aid in understanding how L. monocytogenes survives on dried legumes, seeds, and spices, and the data can contribute to the risk assessment of this pathogen.

Virtual reality for pain management in patients with heart failure: Study rationale and design.

BACKGROUND: Patients with advanced heart failure commonly experience acute and/or chronic moderate to severe pain related to disease, treatment, or both. While pain management strategies typically focus on drug therapies, non-pharmacological interventions may prove beneficial without risk of significant clinical side effects or contraindications. One novel strategy, virtual reality, has been shown to improve pain control in addition to usual pharmacological interventions. METHODS: This is a prospective, two-armed, single center randomized controlled pilot study of a virtual reality intervention in 128 hospitalized subjects with ACC/AHA stage C or stage D heart failure who self-report pain rated 4/10 or greater compared to an active control, two-dimensional guided imagery. The primary outcome is change in self-reported pain score measured by the Brief Pain Inventory (Short Form). Secondary end points include changes in self-reported distress, quality of life, and satisfaction with pain management. CONCLUSION: This randomized controlled study aims to provide empiric data to support application and expansion of novel technologies such as virtual reality to augment usual pharmacological pain management strategies in hospitalized patients with heart failure.

Fate of Listeria monocytogenes in Ready-to-Eat Refrigerated Dips Treated with High Pressure Processing.

Various outbreaks and recalls have been associated with Listeria monocytogenes contamination of ready-to-eat (RTE) food products, including dips. High pressure processing (HPP) is useful for reducing levels of bacteria in many RTE food products, but its efficacy for reduction of pathogens in RTE dips is not well understood. In this study, laboratory-prepared hummus, tahini, baba ghanoush, guacamole, and pesto were initially treated with HPP at 350 MPa for up to 240 s to assess L. monocytogenes inactivation and determine D-values. D350 MPa-values in hummus, guacamole, and baba ghanoush were 105.3, 71.3, and 34.0 s, respectively. No significant reduction in L. monocytogenes levels was observed in tahini or pesto at 350 MPa for 240 s or after additional treatment for up to 600 s at 600 MPa (P > 0.05). Overall, the results of this study highlight the efficacy of HPP for reducing L. monocytogenes levels in certain RTE dips and but not in others.

Top Qualifications Hospitalist Leaders Seek in Candidates: Results from a National Survey.

Despite rapidly growing interest in Hospital Medicine (HM), no prior research has examined the factors that may be most beneficial or detrimental to candidates during the HM hiring process. We developed a survey instrument to assess how those involved in the HM hiring process assess HM candidate attributes, skills and behaviors. The survey was distributed electronically to nontrainee physician Society of Hospital Medicine members. Respondents ranked the top five qualifications of HM candidates and the top five qualities an HM candidate should demonstrate on interview day to be considered for hiring. In thematic analysis of free-response questions, several themes emerged relating to interview techniques and recruitment strategies, including heterogeneous approaches to long-term versus short-term applicants. These findings represent the first published assessment in the area of HM hiring and should inform HM candidates and their mentors.